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Surveillance Update No. 4
April 2011
Chronic Obstructive Pulmonary Disease (COPD) and Comorbidities
North Carolina 2009
The Behavioral Risk Factor Surveillance System (BRFSS) is a random telephone health survey of non-institutionalized adults aged 18 and older in households sponsored by the Centers for Disease Control and Prevention (CDC). The North Carolina BRFSS operates through the State Center for Health Statistics’ Survey Center, Division of Public Health, conducting interviews monthly in both English and Spanish. Go to www.schs.state.nc.us/SCHS/brfss/questions.html to view the 2009 questionnaire. For more detailed information about the survey, please visit the NC-BRFSS website at www.schs.state.nc.us/SCHS/brfss or contact the BRFSS Coordinator at (919) 855-4485.
Background
Chronic Obstructive Pulmonary Disease (COPD) is a lung disease characterized by chronic inflammation of the airways. The primary risk factor for COPD is cigarette smoking; other risk factors include long-term exposure to environmental lung irritants and certain genetic conditions.1 COPD is also found to be associated with significant comorbidities, including heart disease, kidney disease, asthma, and arthritis, as well as various types of cancer.2 A large-scale study, using electronic primary care records of more than 1.2 million patients, found that COPD was associated with significantly higher odds of cardiovascular disease, stroke, and diabetes mellitus.3 There is growing evidence to suggest that systemic inflammation is potentially a common pathway for multiple chronic conditions found among adults with COPD.4
COPD can adversely affect one’s quality of life (QoL). Depression has often been associated with COPD. In an observational study of 35,722 patients with COPD, the incidence rate of new-onset diagnoses of depression was significantly higher in the COPD group, compared to the COPD-free group.5 Sleeping difficulties and physical inactivity are also common among those with COPD.6,7
The aim of this report is to enumerate the prevalence and risk of secondary chronic diseases, and poor quality of life, among North Carolina adults with COPD.
Methods
The study results were derived from the 2009 BRFSS (Behavioral Risk Factor Surveillance System) telephone survey of North Carolina adults, ages 18 and older. An affirmative response to the COPD screener question: “Have you ever been told by a doctor or health professional that you have COPD, emphysema, or chronic bronchitis?” defined the COPD study population. The comparison group consisted of all those who responded “no” to the screener question. There were 993 respondents who met the definition for COPD and 11,344 respondents who did not have COPD.
Poor quality of life was assessed from three questions, based on the number of self-reported days out of the past 30 days when (1) mental health was not good, (2) daily activity was restricted due to poor health, and (3) self-reported days of not having enough rest or sleep. For each question, the report of 14 or more days defined poor QoL. Lack of exercise in the past month was also examined as a QoL measure (Table 1). Seven chronic diseases were delineated from the
Table 1.
Weighted Prevalence and Age-adjusted Relative Risk of
Poor Quality of Life Among Adults With and Without COPD:
2009 NC BRFSS Survey (N=12,337)
Prevalence
Relative Risk
Poor Quality of Life
COPD %
No COPD %
aRR
95% C.I.
Number of days in past 30 when mental health not good
14 to 30 days
24.0
10.8
2.44*
1.90–3.12
Number of days in past 30 when poor health1 restricted activities
14 to 30 days
31.3
12.8
2.10*
1.67–2.65
Number of days in past 30 with not enough rest or sleep
14 to 30 days
40.5
27.8
1.66*
1.41–1.95
Participate in any exercise activities in past month
None
42.4
25.2
1.57*
1.36–1.80
Abbreviations: COPD – chronic obstructive pulmonary disease; aRR – age-adjusted relative risk.
*Statistically significant p < 0.05
1Poor health includes poor mental or physical health.survey: arthritis, diabetes, heart attack, coronary heart disease, stroke, kidney disease, and current asthma. A summary indicator variable, “Chronic disease index,” was constructed for those having three or more chronic diseases, among the seven studied (Table 2).

Surveillance Update No. 4
April 2011
Chronic Obstructive Pulmonary Disease (COPD) and Comorbidities
North Carolina 2009
The Behavioral Risk Factor Surveillance System (BRFSS) is a random telephone health survey of non-institutionalized adults aged 18 and older in households sponsored by the Centers for Disease Control and Prevention (CDC). The North Carolina BRFSS operates through the State Center for Health Statistics’ Survey Center, Division of Public Health, conducting interviews monthly in both English and Spanish. Go to www.schs.state.nc.us/SCHS/brfss/questions.html to view the 2009 questionnaire. For more detailed information about the survey, please visit the NC-BRFSS website at www.schs.state.nc.us/SCHS/brfss or contact the BRFSS Coordinator at (919) 855-4485.
Background
Chronic Obstructive Pulmonary Disease (COPD) is a lung disease characterized by chronic inflammation of the airways. The primary risk factor for COPD is cigarette smoking; other risk factors include long-term exposure to environmental lung irritants and certain genetic conditions.1 COPD is also found to be associated with significant comorbidities, including heart disease, kidney disease, asthma, and arthritis, as well as various types of cancer.2 A large-scale study, using electronic primary care records of more than 1.2 million patients, found that COPD was associated with significantly higher odds of cardiovascular disease, stroke, and diabetes mellitus.3 There is growing evidence to suggest that systemic inflammation is potentially a common pathway for multiple chronic conditions found among adults with COPD.4
COPD can adversely affect one’s quality of life (QoL). Depression has often been associated with COPD. In an observational study of 35,722 patients with COPD, the incidence rate of new-onset diagnoses of depression was significantly higher in the COPD group, compared to the COPD-free group.5 Sleeping difficulties and physical inactivity are also common among those with COPD.6,7
The aim of this report is to enumerate the prevalence and risk of secondary chronic diseases, and poor quality of life, among North Carolina adults with COPD.
Methods
The study results were derived from the 2009 BRFSS (Behavioral Risk Factor Surveillance System) telephone survey of North Carolina adults, ages 18 and older. An affirmative response to the COPD screener question: “Have you ever been told by a doctor or health professional that you have COPD, emphysema, or chronic bronchitis?” defined the COPD study population. The comparison group consisted of all those who responded “no” to the screener question. There were 993 respondents who met the definition for COPD and 11,344 respondents who did not have COPD.
Poor quality of life was assessed from three questions, based on the number of self-reported days out of the past 30 days when (1) mental health was not good, (2) daily activity was restricted due to poor health, and (3) self-reported days of not having enough rest or sleep. For each question, the report of 14 or more days defined poor QoL. Lack of exercise in the past month was also examined as a QoL measure (Table 1). Seven chronic diseases were delineated from the
Table 1.
Weighted Prevalence and Age-adjusted Relative Risk of
Poor Quality of Life Among Adults With and Without COPD:
2009 NC BRFSS Survey (N=12,337)
Prevalence
Relative Risk
Poor Quality of Life
COPD %
No COPD %
aRR
95% C.I.
Number of days in past 30 when mental health not good
14 to 30 days
24.0
10.8
2.44*
1.90–3.12
Number of days in past 30 when poor health1 restricted activities
14 to 30 days
31.3
12.8
2.10*
1.67–2.65
Number of days in past 30 with not enough rest or sleep
14 to 30 days
40.5
27.8
1.66*
1.41–1.95
Participate in any exercise activities in past month
None
42.4
25.2
1.57*
1.36–1.80
Abbreviations: COPD – chronic obstructive pulmonary disease; aRR – age-adjusted relative risk.
*Statistically significant p < 0.05
1Poor health includes poor mental or physical health.survey: arthritis, diabetes, heart attack, coronary heart disease, stroke, kidney disease, and current asthma. A summary indicator variable, “Chronic disease index,” was constructed for those having three or more chronic diseases, among the seven studied (Table 2).